Prognosis unclear, health care reform won’t come easily

Caleb Staley couldn't break the cycle.

Though educated, the 34-year-old Marion man couldn't find a job. Without a job, he couldn't afford health insurance. Without insurance, he couldn't afford treatments for a hearing condition that could help him land a job. A pile of medical bills grew.

Staley's situation illustrates one of many issues in the nation's health care dilemma. As congressional lawmakers debate how the system should be reformed, Iowans are weighing in. Concerns include access to, limitations on and the costs of health care.

Carol Cady, a Cedar Rapids nurse who works in long-term care, said she believes in controlling costs but questions what would happen under a government-run health care system.

“I sincerely believe our elderly, who have made this nation, will be on rationed care if nationalized health care is adopted,” she said. “Government would have to decide if our slim resources would assign any value to the life of a 90-year-old. I do not want to go down the same road as Canada and (Europe).”

Staley finally received help through Linn County Project Access, which helped him work out a plan for his medical bills and directed him to a group through which he obtained hearing aids.

An information technology graduate from the former Hamilton Business College, Staley recognizes the need for health care reform but wonders if government proposals could help everyone.

“Ideally, it would offer something that still gives me the freedom to choose my doctors and where I can go and not limit which treatments I can get,” he said.

Staley noted that, even when he had insurance, hearing aids were not covered.

The complexity and breadth of health care reform doesn't lend itself to an easy or inexpensive fix, and the debate is complicated by a barrage of voices from the millions of people the issue affects.

Families USA notes that escalating health care costs will cause 43,800 Iowans and 6.9 million more Americans to lose their health coverage between January 2008 and December 2010. Current estimates place the number of uninsured Americans overall at 46 million.

The huge cost of reform raises doubts for many Americans. Others, including President Barack Obama, say the country cannot afford not to change because the skyrocketing costs of the current system are unsustainable. With so many Americans uninsured, that argument goes, we all pay for their emergency care in the increasing prices of insurance premiums, hospital stays and other medical treatments.

Studies have shown that more than half of all bankruptcies are because of medical debt, with most of those filed by Americans who have insurance.

As the cost of insurance escalates, fewer employers can afford health benefits for their employees. The recession has exacerbated the problem.

“This is killing small business owners,” said Allen Witt, owner of the 20-employee Hall & Hall Engineers of Hiawatha and Coralville.

Witt, who chairs the Cedar Rapids Area Chamber of Commerce, would like to see small companies join a nationwide pool to increase their collective negotiating power with insurance companies. He also advocates debating health care reform in town hall-style forums.

Wellmark Blue Cross and Blue Shield, Iowa's largest health insurer, supports reform but not proposals to create a so-called public option for the non-Medicare population. The insurer believes a government-run plan would have the federal government determine benefits, premiums and payments to physicians and hospitals.

None of the public option plans being considered in Congress is yet that specific. But most of them would be modeled on Medicare, a government-run health insurance plan for the elderly.

A public option, Wellmark officials said in a statement, would take away the employer coverage people enjoy, undermine current reforms to improve quality and control costs, and perpetuate a reimbursement system that underpays Iowa physicians and hospitals.

Proponents of a public option say it would provide needed competition for the health insurance industry and help drive down insurance costs.

Free clinics and programs such as Linn County Public Access, which matches low-income, uninsured adults with doctors willing to donate their services, have been developed as safety nets. Some of the clinics are stretched to their limits, though, and most are not designed to address chronic conditions that consume much of the nation's health care spending.

Cedar Rapids health care leaders recently were invited to Washington, D.C., along with representatives of nine other communities nationwide, as examples of successful models for achieving high-quality care at reduced costs.

Tim Charles, CEO of Mercy Medical Center, said the communities had some common characteristics - collaboration among physicians, innovation, strong primary care networks and a not-for-profit culture.

St. Luke's Hospital CEO Ted Townsend said Congress is directing its efforts at the wrong problem - focusing on access to insurance, a public option and how to pay for that option.

“Those are symptoms of the disease,” he said, calling the nation's system one of sick care rather than health care.

Townsend said attention would be better focused on incentives to keep people healthy and living within budgets.

“I do believe we need change and we need reform,” he said. “I think the system is broken, but I prefer that it be done well, rather than be done fast.”